Big Bite: Puberty Blockers are Reversible?

Big bite | A detailed dive into big news

U.S. Department of Health and Human Services (HHS) issued an official document entitled "Gender-Affirming Care and Young People."

HHS Office of Population Affairs, unsupported claim of the reversibility of puberty blockers, in their Gender Affirming Care and Young People guidlenes.

Puberty blockers are gonadotropin-releasing hormone agonists, known as Lupron (Leuprolide).

Lupron is used to treat prostate cancer, endometriosis, fibrous, and central precocious puberty (CCP).

Some known side effects of on-label use of Lupron

• may cause impotence

• loss of bone density

• testicular atrophy

• increase risk of heart attack and stroke

Off-label uses for Lupron are puberty blockers as part of “gender-affirming care” in children and chemical castration for sex offenders.

Lupron and other puberty blockers that are used to halt Central Precocious Puberty have been shown to be reversible. In the treatment of CPP the child stops using the puberty blockers once they reach the age of natal puberty. No such studies exist for puberty blockers administered to stop normally timed puberty.

When used in “gender-affirming care” the child's natal puberty is sttopped and if they chose to transition the cross-sex hormones are introduced and the child never goes through natal puberty. There are currently no studies into the long-term effects of children who never experience natal puberty.

Concerns about possible side-effects of off label use

• harm to bone development

• harm to brain development

• unknown effect on other vital organs

• loss of fertility

• unable to experience orgasm

UK’s NHS, updated guidance, “Little is known about the long-term effects of hormone or puberty blockers in children with gender dysphoria”

Sources

• LUPRON DEPOT-PED is the #1 prescribed treatment for Central Precocious Puberty (CPP)

• Castrating chemicals, A sexually abusive doctor claims he's been cured by a testosterone - reducing drug called Lupron. By LEAH KOHLENBERG, Salon

• Science Direct, Chemical Castration, Chemical castration reduces sexual desire and erectile function and leads to testicular atrophy, which may become irreversible over the long term.

• Vrouenraets LJ, Fredriks AM, Hannema SE, Cohen-Kettenis PT, de Vries MC. Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study. J Adolesc Health. 2015;57(4):367-373. doi:10.1016/j.jadohealth.2015.04.004

• O'Connell MA, Nguyen TP, Ahler A, Skinner SR, Pang KC. Approach to the Patient: Pharmacological Management of Trans and Gender-Diverse Adolescents. J Clin Endocrinol Metab. 2022;107(1):241-257. doi:10.1210/clinem/dgab634

• Giordano S, Holm S. Is puberty delaying treatment 'experimental treatment'?. Int J Transgend Health. 2020;21(2):113-121. Published 2020 Apr 11. doi:10.1080/26895269.2020.1747768

• Transgender Trend, Are puberty blockers reversible? The NHS no longer says so

• Mayo Clinic, Pubertal blockers for transgender and gender-diverse youth

• NHS, Treatment-Gender dysphoria

• The NHS has quietly changed its trans guidance to reflect reality, The Spectator

• Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents

• The Cass review, interim report: “it is important that it is not assumed that outcomes for, and side effects in, children treated for precocious puberty will necessarily be the same in children or young people with gender dysphoria.”

• Brain Maturation, Cognition and Voice Pattern in a Gender Dysphoria Case under Pubertal Suppression